Sleeping on the Job Sleep Education for Technologists

Dr Vicky Cooper

Principal Respiratory Physiologist,

Chair, ARTP-SLEEP

Salford Royal NHS Foundation Trust

Acknowledgement : Dr Brendan Cooper

Learning Objectives

• To understand the different levels of staffing and training requirements for sleep technologists /somnologists.

• To understand why there is need for good training.

• To understand the different routes and styles of training.

• To understand current training in the USA, Europe and the UK.

• To understand how the future direction of sleep training in the UK needs to change.

Who measures sleep?

• Doctors

• Nurses

• Scientists

• Technicians/Technologists

• Physiotherapists

• Research staff

Levels of Staff

Assistant Sets up patients, checks signals, downloads equipment (Certificate) Technician, assistant. Practitioner May do set up, troubleshoots signal errors, downloads (B.Sc. degree) data, technical data analyses, sleep stages, etc. Technician, physiologist, technologist, nurse Scientist May do set up, downloads data, technically analyses data, (M.Sc. degree) sleep stages, technical reports, etc. Physiologist, clinical scientist, technologist, nurse, research

scientist Consultant Medical reporting, technically re-analyse data, recommend (Doctoral) pathway actions. Consultant clinical scientist, Physiologist, nurse.

Sleep Study Duties

Staff History Set up Monitor/Adjust

Technical Report

Sleep Stage

Clinical Report

Set up CPAP

Alter CPAP

Doctors ? ? × ? ? ?

Nurses ? ?

Scientists

Technicians & Technologists

?

Respiratory Therapists ?

Research staff × ? ?

? = Sometimes = Usually X = Rarely/never

Why Train Sleep Technologists?

• Increasing demands on medical time

• Increasing incidence of Sleep Disordered Breathing

• Pressure to reduce healthcare costs

• Need for standard education and training in sleep medicine in Europe

• Maintaining quality

• Good training courses in place (ERS, ESRS)

Routes to being a trained sleep technologist / somnologist

International training course (ERS, ESRS, etc.) National training course (ASTEP, CPSGT, RPSGT) National training course (+sleep) (PTP, STP, HSST) In-house training course “On the job” training No training – see one, do one, teach one?

What training?

• How many PSG studies required to be competent setting up a study?

• How many sleep studies required to be able to sleep stage?

• How many CPAP trials required to be competent at setting up CPAP?

• How many CPAP trials required to be able to adjust therapy and make clinical decisions?

Competences

Worldwide Approaches

• Parthasarathy, S. Haynes, P.L et al. A national survey of the effect of sleep medicine specialists and American Academy of Sleep Medicine accreditation on management of obstructive sleep apnea. Journal of Clinical Sleep Medicine. 2006; 2(2). 133 – 142.

• Pevernagie, D. Stanley, N et al. European guidelines for the certification of professionals in sleep medicine: report of the task fore of the European Sleep Research Society. J. Sleep Res. 2009; 18; 136 – 141.

• De Backer, W. Simmonds, A et al. Sleep HERMES: a European training project for respiratory sleep medicine. Eur. Respir. J. 2011a: 38: 496-497.

• ATS/ASDA/ACCP/APCCMPD Statement about training of pulmonary physicians in sleep disorders. American Thoracic Society Archives. Accessed Online.

• BaHammam, A.S, Al-Jahdali, H. Saudi regulations for the accreditation of sleep medicine physicians and technologists. Ann Thorac Med. 2013; 8(1): 3-7.

• McNicholas W.T. & Bassetti C.L.A. Sleep and Breathing Disorders: A multidisciplinary approach. European Resp J. 2013. 22: 197 – 198.

• Mitchell, S Simmonds, A et al. Introducing a core curriculum for respiratory sleep practitioners. Breathe 2015; 50-56.

Current Sleep Training

Staff ERS ESRS USA UK

Doctors HERMES Certified Expert Somnologists

Certification Examination in Sleep Medicine

RCP/HERMES

Nurses HERMES ASTEP/ RPSGT

Scientists/ Technologists

HERMES Certification in Sleep Medicine for Technologists

CPSGT/ASTEP /RPSGT

PTP, STP, HSST

Technicians HERMES ASTEP/ CPSGT/RPSGT

PTP

Respiratory Therapists HERMES CPSGT/ASTEP/ RPSGT

USA Sleep Training • American Academy of Sleep Medicine (AASM): a professional society that is

dedicated exclusively to the medical subspecialty of sleep medicine. The AASM sets standards and promotes excellence in health care, education and research.

• Board of Registered Polysomnographic Technologists (BRPT): an independent, non-profit certification board that oversees a program of competency based testing for sleep technicians and technologists.

• Accredited Sleep Technology Education Program (ASTEP): is an accredited program set up by the American Academy of Sleep Medicine to provide standardized education for sleep trainees and technicians. It contains both ASTEP I, which consists of 80 hours of didactics, and ASTEP II, that consists of 23 teaching modules that are performed online.

• RPSGT : A registered polysomnographic technologist who has become credentialed by the Board of Registered Polysomnographic Technologists.

• CPSGT: The CPSGT certificate is intended specifically for individuals new to a career in sleep. It is valid for three years, carries a continuing education requirement, and is positioned as a solid first step to earning the RPSGT credential.

USA Way

Credentialed healthcare professional with any of the following: RRT, CRT • Pathway 1: Clinical Experience • Minimum of 3 months (paid or non-paid) PSG experience • Completion of STAR-designated self study program (Atlanta School’s Online

Foundation of Sleep Technology or equivalent program) • Proof of completion of secondary education or equivalent. • Pathway 2: CAAHEP/CoARC Student (Commission on Accreditation of Allied Health

Education Programs/ Commission on Accreditation for Respiratory Care)

• Pathway 3: Focused Training

• Completion of STAR-designated Focused education, or a combination of self study and Focused2 education: A-STEP Part 1 and Atlanta School’s Online Foundation of Sleep Technology or equivalent STAR-designated program

• Proof of completion of secondary education or equivalent.

The European Way

European Sleep Research Society

• Need for standard education and training across Europe

• Standard European criteria for accreditation of sleep medicine centres and certification of sleep medicine professionals

• Standard educational materials and standard European education programme

• Catalogue of Knowledge and Skills – essential element for establishing standard training

ESRS Technologist Examination in Sleep Medicine (Part One)

Examination Written test (50 multiple-choice questions)completed on-site. Using ESRS Textbook and 2015 AASM Scoring Manual Version 2.2 (recommended reading) • 23 questions will be related to chapter B (Sleep Diagnostics) • 27 will be related to topics from chapters A, C-J. Pass mark: 50%.

ESRS Technologist Examination in Sleep Medicine (Part Two)

Practical skills Sleep staging, event scoring and interpreting 2 excerpts from PSG and 1 MSLT recording. All consecutive 30-second epochs will be printed on paper. Successful candidates must achieve an 85% concordance with the panel of experts. Both parts must be successfully passed in order to qualify for certification.

ESRS Examination in Sleep Medicine

More detailed and minimum levels of experience for physicians, include; • sleep-breathing disorder (40 cases), • insomnia disorder (10), • hypersomnia, • movement disorder, • circadian disorder (20).

• Experience for psychologists should include insomnia

disorder (40), sleep-breathing disorder, hypersomnia, movement disorder, circadian disorder (30).

The UK Way

?

Associate Level

• ARTP certificate in Oximetry

• ARTP / BSS / BTS Sleep Courses

• Manufacturer’s Course

Practitioner Training Programme

• Overnight Oximetry – Prepare, fit and remove oximetry devices on a range of patients. – Download, perform manual analysis and interpret data and write a technical report in an

appropriate format.

• Multi-channel Limited Sleep Study – Prepare, fit and remove multi-channel polygraphy devices on a range of patients. – Download, perform manual analysis and interpret data and write a technical report in an

appropriate format.

• Positive Airway Pressure Therapy – Set up a range of patients on CPAP / APAP selecting the appropriate settings and interface. – Provide patients with written and verbal instructions and education on the use of CPAP

therapy. – Download a CPAP/ APAP device , interpret the data and write a technical report. – Review patients who have recently started on CPAP therapy or those on long term therapy and

recognize where further intervention is required.

Scientific Training Programme • Perform, analyse and develop skills in the interpretation of overnight oximetry

studies. • Perform a limited multichannel sleep study. • Assist in the routine maintenance, calibration and quality assurance procedures on

the equipment used to undertake ….measurement of overnight pulse oximetry and continuous positive airway pressure (CPAP) equipment.

• Plan, prepare and undertake complete overnight pulse oximetry and limited multichannel recordings in a variety of patient conditions to obtain a range of subjective measurements of sleepiness in patients presenting with excessive daytime sleepiness.

• Plan, prepare and undertake trials of the effectiveness of CPAP therapy to assess patients’ interface requirements and commence ventilation using appropriate settings.

• Interpret data from overnight pulse oximetry and limited multichannel sleep recordings and produce high-quality reports, including recommendations for further management.

• Carry out routine maintenance, calibration and quality assurance procedures on the equipment used to undertake ……, measurement of overnight pulse oximetry and CPAP equipment.

• Perform, analyse and technically report polysomnographic sleep investigations in patients referred to a sleep service.

(STP LG Cardiac, Critical Care, Vascular, Resp & Sleep Final Version 1.0 for 2013-14 )

Higher Specialist Scientific Training

• Clinical Knowledge and Skills in Respiratory and Non-Respiratory Sleep Disorders

• Full PSG analysis with both technical reporting and clinical interpretation.

• CPAP therapy and other modes of ventilation, eg ASV

• Paediatrics

Future Direction for Sleep Training in the UK?

• Speciality in its own right – dedicated curriculum not an add on

• Earlier introduction to PSG (practitioner level)?

• Earlier introduction to non-respiratory sleep disorders?

• Adopt the European Way?

• More training centres required!

Always apply enough electrodes!

Questions/Comments?